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高通量透析改善维持性血液透析患者皮肤瘙痒的临床观察

张敏1,张宇2,龙刚3,王少艳4,毕会4,闫昕4   

  1. 1. 天津市人民医院肾内科
    2. 天津市人民医院
    3. 天津市人民医院移植外科
    4.
  • 收稿日期:2010-01-11 修回日期:2010-03-11 出版日期:2010-11-15 发布日期:2010-11-15
  • 通讯作者: 龙刚

Comparison between effect of highly permeable dialysis and low permeable dialysis on uremic pruritus

  • Received:2010-01-11 Revised:2010-03-11 Published:2010-11-15 Online:2010-11-15

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摘要： 摘 要: 目的 观察高通量透析与低通量透析改善维持性血液透析患者皮肤瘙痒的疗效观察。方法 选择尿毒症皮肤瘙痒患者38例,随机分成观察组及对照组,均采用德国Fresenius 4008S容量控制型透析机和超纯净水碳酸氢盐透析液，分别行高通量透析与低通量透析治疗,每周3次,每次4小时,共观察1年；检测血尿素氮(BUN)、肌酐(Cr)、磷、β2－微球蛋白(β2－M)及甲状旁腺素(PTH)；观察透析前后各种溶质含量的变化，计算溶质清除率和尿素清除指数( Kt/V 值)；用可视模拟评分法评估瘙痒程度。结果 两组透析后BUN、Cr下降率比较差异无统计学意义(P>0.05) ,磷的下降率观察组为(30.4±14.95)%,优于对照组(22.06±8.32)%(P<0.05),β2－M的下降率观察组为(35.12±17.82)% ,优于对照组(1.64±4.93)%(P<0.05),两组Kt/V 比较差异无统计学意义(P>0.05)；治疗1年后观察组PTH(27.54±19.43)pmol/L,显著低于对照组(43.31±19.59)pmol/L(P<0. 05),皮肤瘙痒与治疗前比较两组均有减轻(P<0.05),观察组瘙痒程度评分为(2.66±1.16)分,显著低于对照组(5.53±1.56)分(P<0.05)。结论 高通量透析与低通量透析相比,在保证对小分子毒素充分清除的基础上,增加了对于大、中分子毒素的清除,可以明显减轻维持性血液透析患者顽固性皮肤瘙痒症状。

关键词: 高通量透析, 血液透析, 皮肤瘙痒

Abstract: ABSTRACT: Objective To investigate the mechanism and the effect of highly permeable dialysis and low permeable dialysis on uremic pruritus. Methods Thirty-eight patients of uremic pruritus studied were randomly divided into observed group and control group. Nineteen cases received high permeable dialysis (observed group) and the others received low permeable dialysis (control group) with three times-weekly session of 4 hours following up one year. All patients were dialyzed with Fresenius 4008S. Blood urea nitrogen(BUN) , creatinine ,phosphate ,β2- microglobulin and parathyroid hormone(PTH) were tested and solute clearance and Kt/ V value was figured out. The degree of skin itch was evaluated by the visual analogue scales (VAS). Results There was no significant difference between observed group and control group in the decrease of BUN ,creatinine(P>0.05). But the decreases of phosphate andβ2-microglobulin of observed group were superior to that of control group, (30.4±14.95) % and (35.12±17.82) % vs (22.06±8.32) % and (1.64±4.93) %(P<0.05) . And there was no difference in Kt/ V value between the two groups(P>0.05) . After one year ,the decrease of PTH of observed group was superior to that of control group (27.54±19.43)pmol/ L vs (43.31±19.59) pmol/ L(P<0.05) and compared to pretreatment ,skin itch was relieved in both groups(P<0.05) ,but observed group was superior to control group , (2.66±1.16) scores vs (5.53±1.56) scores (P<0.05) . Conclusion Compared to low permeable dialysis, highly permeable dialysis,which not only cleared the micromolecule toxins,but increased the clearance of macro-middle molecule toxins,can significantly relieve uremic pruritus.

Key words: highly permeable dialysis, dialysis, uremic pruritus